Purpose We investigated if the use of peripheral nerve blockade (PNB) was associated with a lower incidence of prescription opioid fill within 30 days post-surgery and persistent postoperative opioid use (PPOU) in patients undergoing foot and ankle surgery.

Methods We identified adults who had undergone foot or ankle surgery between 2012 and 2018 and did or did not receive PNB in an Optum’s de-identified Integrated Claims-Clinical dataset (n=12,643). Pharmacy data was used to track opioid prescription fill date and supply. PPOU was defined as >90 days of continuous opioid use. Entropy balancing was used to control differences in the distribution of covariates. Log-binomial models in unweighted and weighted data estimated crude and adjusted relative risk (RR) with 95% confidence intervals (CI) for the outcomes.

Results One-third of the sample filled an opioid within 30 days of surgery, and among these patients, 57.3% continued use for > 90 days. Performance of PNB was associated with an increased risk for filling opioid prescriptions within 30 days post-surgery before (RR=1.40; 95%CI:1.32-1.49) and after (RR=1.31; 95%CI:1.22-1.41; p<0.0001) controlling for confounding. However, the group that received a PNB showed significantly lower risk of PPOU before (0.91; 95%CI:0.85-0.98; p=0.016) and after controlling for confounding (RR=0.92; 95%CI:0.85-0.99; p=0.029).

Conclusion Performance of PNB for patients undergoing foot and ankle surgery was associated with a 31% increased risk of any opioid prescription fill within 30 days after surgery. However, among the patients that initially filled their prescriptions, patients that received PNB had a significantly (8%) lower risk for PPOU.

The authors have declared no competing interest.

This work was supported by resources from the Saint Louis University Advanced HEAlth Data (AHEAD) Research Institute and the Department of Anesthesiology. Development and maintenance of the Virtual Data Warehouse was made possible by a Saint Louis University Research Institute grant. The funders had no role in the design, data collection, data analysis, and reporting of this study.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The dataset provided by Optum was de-identified by the company. This study was evaluated by the Saint Louis University Institutional Review Board (IRB) and determined to be exempt from review

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